Provider Demographics
NPI:1558777623
Name:BALDWIN, KAYLA R (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:R
Other - Last Name:THEISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8322 E MCDOWELL RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3820
Mailing Address - Country:US
Mailing Address - Phone:480-941-4169
Mailing Address - Fax:480-941-4972
Practice Address - Street 1:8322 E MCDOWELL RD
Practice Address - Street 2:STE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3820
Practice Address - Country:US
Practice Address - Phone:480-941-4169
Practice Address - Fax:480-941-4972
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist